Physical Examination of the Abdomen Flashcards
What are the core examination skills in an abdominal exam?
Inspection, auscultation, percussion, palpation.
What types of medications are concerning for a patient with constipation?
Antihistamines and narcotics.
What should you do to prepare and position your patient for an abdominal exam?
1) Patient should have an empty bladder.
2) Approach patient from their right side.
3) Place patient supine with knees slightly flexed and feet flat on bed.
4) Fully expose abdomen.
5) Ensure patient is comfortable.
What should you ask female patients complaining of GI issues?
First day of last menstrual period.
Why should you have your patient take a deep breath and hold during an abdominal exam?
It lowers the diaphragm.
What occurs when you have your patient lift his head off of the table when he is laying supine?
It contracts the rectus abdominis muscles. The rectus will contract or show signs of separation indicative of diastasis recti, hernia, or masses.
Visible intestinal peristalsis may indicate what?
Intestinal obstruction
- Males: abdominal movement
- Females: costal movement
Venous patterns
Lesions
What are Cullen sign and Gray-turner sign, and what do they indicate?
Cullen: bluish periumbilical discoloration that suggests intraabdominal bleeding.
Gray-Turner: bluish flank discoloration suggests retroperitoneal or intraabdominal bleeding.
Purplish striae on the abdomen, moon face and buffalo hump are indicative of what condition?
Cushing Syndrome
Asymmetrical distention may indicate what disorders?
Hernia, tumors, cysts, bowel obstruction, enlargement of abdominal organs.
How are bowel sounds heard during auscultation, and how long do you listen to them?
They are heard as clicks and gurgles that occur irregularly and range from 5-35 per minute.
You must listen for 5 minutes to document absent bowel sounds.
What are borborygmi?
Loud, prolonged gurgles.
Increased bowel sounds can be caused by what conditions?
Gastroenteritis, early intestinal obstruction, hunger
A high pitched tinkling sound indicates what?
Intestinal fluid and air under pressure, as in early obstruction.
Decreased bowel sounds occur with what conditions?
Peritonitis and paralytic ileus.
When percussing the abdomen, why do you start with overall percussion?
To get a sense of overall tympany and dullness.
Examine tender/painful areas last.
Note size and density of abdominal organs.
The dullness of a healthy spleen is often obscured by what?
Colonic air.
What is the average size of the liver?
6-12cm.
The gastric bubble is ____ in pitch than normal tympany of the intestine.
Lower
What is the landmark for percussing the kidneys, and what position do you place your patient?
Costovertebral angle, sitting
What are ascites?
Excessive intraabdominal fluid buildup
When palpating the epigastric area for aortic pulsation, what sensation is indicative of an aortic aneurysm?
A prominent lateral pulsation.
What is ballottement used to assess?
Floating masses.
A positive rebound tenderness test appears in what manner, and indicates what?
Sharp stabbing pain when you remove your hand from their abdomen at the site of peritoneal inflammation. (Blumberg sign)
Rebound tenderness over McBurney’s point in the RLQ suggests appendicitis (positive McBurney’s).
The Markle test is used to assess what?
Peritoneal irritation. A positive test will illicit abdominal pain.
Rovsing sign is used to assess what? What is a positive finding?
Appendicitis. Increased RLQ pain with palpation of the LLQ is positive.
What is the iliopsoas muscle test used for? What is a positive finding?
Used to test for appendicitis (i.e. retrocecal appendicitis). Pain in the abdomen is a positive sign.
What is the obturator muscle test used for, and what is a positive finding?
Used to assess for appendicitis or pelvic abscess. Abdominal pain is a positive finding.
What test is used to assess for gallbladder irritation?
Murphy’s sign. Abrupt cessation of inspiration during this test is a positive finding and is suggestive of cholecystitis.
What is the reason for asking your patient to bear down during a rectal exam?
To make fistulas, fissures, rectal prolapses, polyps, and internal hemorrhoids more apparent.
During a rectal exam of the anal ring, you note that your patient’s sphincter is lax. What could be the cause?
Neurological injury or deficit.
What surface of the prostate gland will be palpable during a rectal exam?
The posterior surface of the gland palpable through the anterior rectal wall.
What stool characteristics require a digital rectal exam?
Persistent pencil like stool
-Permanent stenosis from scarring or malignancy
Light tan/gray stool
-Obstructive jaundice
Tarry black stool
-Upper GI bleed
Bright red blood in stool
-Lower GI bleed
A stony, hard nodular prostate indicates what?
Carcinoma, calculi, chronic fibrosis.
A fluctuant, soft prostate indicates what?
Prostatic abscess
Tenderness and inflammation of the perianal area suggests what?
Abscess, anorectal fistula or fissure, pilonidal cyst, pruritus ani
What is the normal size of the prostate gland?
4cm in diameter and no less than 1cm protrusion into the rectum
